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Silent myocardial ischemia: Prognosis and therapy

Author
Prakash C Deedwania, MD
Section Editor
Juan Carlos Kaski, DSc, MD, DM (Hons), FRCP, FESC, FACC, FAHA
Deputy Editor
Brian C Downey, MD, FACC

INTRODUCTION

Angina pectoris, the term used for symptoms thought to be attributable to myocardial ischemia, typically manifests as chest discomfort, although other associated symptoms with ischemia may be present (eg, exertional shortness of breath, nausea, diaphoresis, fatigue). While angina has long been considered the cardinal symptom of myocardial ischemia and coronary heart disease, "silent" (asymptomatic) myocardial ischemia is the most common manifestation of coronary heart disease (CHD), accounting for more than 75 percent of ischemic episodes during daily life as assessed by electrocardiographic (ECG) monitoring [1]. (See "Angina pectoris: Chest pain caused by myocardial ischemia".)

Issues related to treatment and prognosis of silent myocardial ischemia will be reviewed here. The epidemiology, pathophysiology, and diagnosis of silent myocardial ischemia are discussed separately. (See "Silent myocardial ischemia: Epidemiology, pathophysiology, and diagnosis".)

DEFINITION

Silent myocardial ischemia is defined as the presence of objective evidence of myocardial ischemia in the absence of chest discomfort or another anginal equivalent symptom. Objective evidence of silent myocardial ischemia may be obtained through ambulatory electrocardiographic (ECG) monitoring or cardiac stress testing. (See "Silent myocardial ischemia: Epidemiology, pathophysiology, and diagnosis", section on 'Definition'.)

PROGNOSIS

The prognosis of patients with silent myocardial ischemia may be viewed from the standpoint of two groups of patients: those without a history of coronary heart disease (CHD) or angina pectoris, and those with a history of CHD [2]. Additionally, there appears to be a "dose dependence," with patients who have more frequent or more sustained episodes of silent ischemia at greater risk for adverse events [3,4].

The precise reason for the adverse prognosis associated with silent ischemia is not known. Hypotheses center around abnormalities such as necrosis or progressive fibrosis leading to left ventricular dysfunction and/or ventricular arrhythmias [5-7].

               

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Literature review current through: Nov 2016. | This topic last updated: Fri Nov 18 00:00:00 GMT 2016.
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